=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548521727
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHEASTERN PSYCHIATRIC MANAGEMENT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2012
-----------------------------------------------------
Last Update Date | 03/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 SCENIC HIGHWAY
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-413-1880
-----------------------------------------------------
Fax | 256-413-1882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 8406
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-546-9265
-----------------------------------------------------
Fax | 256-549-0376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR/CEO
-----------------------------------------------------
Name | DR. GEORGE MICHAEL SHEHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 256-546-9265
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 201292924
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------